| NPI | 1104522721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 20534) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 84722) |
| 101YP2500X Counselor, Professional (Licence: CA 20534) | |
| 101YM0800X Counselor, Mental Health (Licence: PA PC015754) | |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2026-04-13 |